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This year, spring clean your diet, too. "Clean" eating means to create a balanced diet of fresh, unprocessed foods with the central focus on fruits and vegetables. The health benefits of clean eating are many, such as possible weight loss and the reduction
of one's risk for diabetes and some types of cancer, including colon cancer.

The experts at NorthShore University HealthSystem have created an infographic that illustrates the benefits of clean eating and breaks down the most important clean eating guidelines. Click on the image below to view the
full infographic.

Spring is on its way, which means athletes everywhere are emerging from
hibernation and throwing on their running shoes. Before you join their ranks, follow along as
Adam Bennett, MD, Sports Medicine at NorthShore, answers our sports-injury prevention questions, from what changes you should make to your diet if you’re in training, to what you should do if training starts to hurt:

If you experience pain while in training for an athletic event, what are your options?
The main issue is to determine the cause of the pain. If the cause is muscle soreness, then more rest between runs or training may help. Additionally, some strength training via yoga, Pilates or basic weight lifting
may diminish soreness after a workout. If pain persists, seek medical care, which could include X-rays depending on the site and severity of the pain.

What causes shin splints and what is the best way to deal with them and still be able to exercise?
First order of business is to make sure that your shin splints are in fact, shin splints. Other causes of shin pain include muscle strains, stress fractures and tendinitis. "Shin splints" is a painful condition that occurs when the muscle attachments pull on
the periosteum (a membrane that covers bones) of the tibia, which leads to inflammation and pain. If you do have shin splints, anti-inflammatory over-the-counter pain relievers, intense stretching, deep tissue massage, gait analysis, modifying the type of
shoe you wear and rest days in your training program all may help diminish your symptoms. Formal physical therapy is an effective way to implement all of these strategies.

Are sports and recovery drinks after a workout or training better than simply drinking water? Do they aid recovery?Sports drinks contain glucose and electrolytes, which need to be replenished after sweating during training
or exercise. Sports drinks are probably not essential for exercise lasting 20 minutes or less. For exercise lasting longer than 20 minutes, research shows improved performance when utilizing fluids that contain glucose and electrolytes. Research also indicates
that ingesting carbohydrates and protein within 10 minutes of an intense workout improves recovery. I don’t have brand recommendations but I believe it’s a good idea to replenish with a drink that uses natural flavors and sweeteners and avoids ingredients
like high fructose corn syrup. Certainly anything with caffeine, which might dehydrate the athlete, is a bad idea. Please tell your kids not to drink soda pop after exercise.

Is it better to consume protein drinks or food sources of protein after a workout for muscle recovery?
I would guess they are about equivalent. The advantage of a drink is that you replenish fluids as well.

If you have an injury in your arms or wrists, such as tendonitis, what exercises could you do to increase strength without causing further injury?This is a tough scenario but there are things you can do. Specifically putting resistance in your mid-forearm and keeping your hands and wrists relaxed can allow you to work out the major muscles of your upper body without irritating the tendons in your
wrists. If you’re having trouble figuring out how to pull this off try working with a personal trainer a couple of times and have him or her show you.

For those training for a marathon, half marathon or triathlon, do you have any diet and training recommendations?
My first recommendation is to consider implementing rest days as part of your training. I often suggest athletes work longer and more intensely one day and then allow for complete rest the next day. If that is too much rest, consider a two-days-on, one-day-off
schedule. Rest days allow for replenishment of glycogen stores in the muscle cells and fluid losses to be replaced adequately. As a result, athletes typically feel better on workout days and can push themselves even harder, which ultimately leads to a better
performance on race day.

In terms of a daily diet, avoiding fried foods, caffeine and alcohol is likely to bring benefit. If you sweat a lot, you may need to add salty foods to your diet. This is especially important if you cramp easily.

For those not in training but who still want a great workout, what would you recommend?
High-intensity interval training is likely the most effective way to improve overall fitness. For my patients who are frustrated with their ability to lose weight, I often suggest they incorporate high-intensity interval training into their workout routine.
Crossfit is a popular example, which works for some, but there are many ways to do this type of training.

If you are concerned about the risk of injury during strength training as an older athlete, what should you do? Are lighter weights with more reps better? Or, should you increase weight and reduce reps?
Most people don't realize the importance of resistance training to overall health. My only concern about injury is if you had arthritis in any of your upper extremity joints (shoulder, elbow, wrists). If you do have arthritis in these joints, then lighter weights
would be preferred. If you continue to lift to the point your muscles become sore the next day, it is unlikely you will lose significant muscle mass. My only suggestion is to vary the weight, repetitionor motion of your regimen so your body won’t adapt as easily. This will ensure maximum benefit from every session.

For more information on keeping your young athletes healthy, join us on
Thursday, March 20th from 7:00-8:30 p.m. for a Sports Medicine Symposium at Highland Park High School. We invite you to join us for a discussion on how to keep young athletes in optimum health and prevent injuries. For more information, call
Matt Castle at 224-765-2090.

A lack of sleep can leave you feeling groggy and foggy all day, impairing your ability to focus on work and even retain information.
That’s not all; lack of sleep also decreases libido, ages skin and can inhibit your ability to lose weight. Chronic sleep deprivation—regularly forgoing the recommended 7 to 8 hours or due to other sleep disorders—can have serious consequences on your health,
including increased risk for heart disease, heart attack, stroke, high blood pressure, diabetes and depression. In other words, maintaining good sleep habits is an essential part of a healthy lifestyle. And, unfortunately, most of us aren't doing that.

If done correctly, there is great power in a well-timed nap. While you should not rely on naps to repair the damage done by inadequate sleep or chronic sleep deprivation, naps can recharge your energy levels and improve your mood. The key is to time them
just right. Short naps are preferable. Longer naps may be taken on occasion to make up for an occasional lapse in sleep schedule.

Thomas Freedom, MD, Neurologist and Program Director of Sleep Medicine at NorthShore, breaks down nap time to help you achieve maximum
benefits from a little daytime shuteye:

10 to 20 minutes. Often called the “power nap,” this short rest period is a great way to recharge your personal energy battery, boosting alertness and increasing your midday focus. Keep your power naps to 10 to 20 minutes because you’ll
stay in lighter stages of non-rapid eye movement (NREM), which means you won’t wake up feeling groggy and can get right back to work feeling refreshed. Also try to take the nap early in the afternoon.

30 minutes or more. Word of warning: Naps longer than 20 minutes could leave you with sleep inertia, or grogginess that can last up to 30 minutes after waking. If you need to be back on your feet right away, keep your nap to less than 20
minutes. Otherwise, after the fog wears off, you’ll enjoy the same restorative benefits of the power nap.

60 minutes. If you find yourself forgetting information halfway through your day, 60 minutes of shuteye might be able to help. A nap between 30 and 60 minutes will get you to slow-wave sleep, which can help improve your decision-making skills
and recollection of information. You’ll need to give yourself a little recovery time after an hour nap, as the effects of sleep inertia could be more pronounced. There is a possibility that a nap of this length could also disrupt your sleep at night.

90 minutes. A 90-minute nap gives you a full sleep cycle—from the lighter stages of sleep all the way to REM (rapid eye movement). A nap of 60 to 90 minutes can improve decision-making skills and even enhance creativity. At this length,
make sure to nap with care. You don’t want to disrupt your regular sleep schedule or keep yourself up at night by napping too long during the day. Sleep inertia may also be more of an issue.

Today, bullying doesn’t necessarily stop once your child walks through the front door. Cyberbullying, an extension
of traditional bullying, uses electronic technology and communication mediums—from emails and texts, to messages on social media sites like Facebook and Twitter—to send threatening and insulting messages anytime and anywhere. How do you protect your child
when the threats are happening online? What is the role and responsibility of the school when bullying is happening both on and off school grounds? How do you know when it’s happening to your child?

Benjamin Shain, MD, PhD, Child-Adolescent Psychiatry, answers questions on cyberbullying and bullying to help parents and teachers
find the best and most effective ways to protect kids:

How is bullying defined?
Bullying has been defined as having three elements: aggressive or deliberately harmful behavior 1) between peers that is 2) repeated and spans a length of time and 3) involves an imbalance of power, (e.g., related to physical strength or popularity), making
it difficult for the victim to defend himself or herself. Bullying behavior falls into four categories: 1) direct-physical (e.g., assault, theft), 2) direct-verbal (e.g., threats, insults, name-calling), 3) indirect-relational (e.g., social exclusion, spreading
rumors), and 4) cyber. The 2011 Youth Risk Behavior Survey of students in grades 9 through 12 in the United States indicated that during the 12 months before the survey, 22.0% of girls and 18.2% of boys were bullied on school property, 22.1% of girls and 10.8%
of boys were electronically bullied, and 6.0% of girls and 5.8% of boys did not go to school one day in the past 30 because they felt unsafe at school or on the way to or from school.

How can you tell the difference between a joke and cyberbullying? When should you be concerned? When should you get the other parents involved?
Note the definition of bullying in the above question. Look for repeated aggressive or harmful behaviors involving an imbalance of power. That said, there is little you can do to monitor without being highly intrusive. Some teens need this but most do not.

What is the best way for schools to handle cyberbullying when they find out about it? Is it different from the way they would or should handle regular bullying?
There is little difference in consequence between cyberbullying and the face-to-face variety. Schools are in a unique position to intervene. Parents are limited in what they can do and most bullying does not meet the threshold for legal involvement. My belief
is that schools should handle all bullying as bullying.

How does a parent’s use of computers impact children? How can we set healthy examples that could contribute to less negative, and potentially bullying, situations?
Children learn more by example than what we tell them. I don't think we can have rules that apply to all (e.g., limit screens to X hours per day) as there is wide variation in needs and abilities of both parents and children. However, parents should consider
rules when usage becomes excessive (e.g., seems to limit other activities) and redirection is not effective. How to handle bullying (as both victim and bully) can be modeled by example, as well, with parents talking about how they handle electronic situations
as they arise.

How closely should you watch the way your kids use Facebook and their phone? Is it going too far to ask to see messages they send and receive?
Think of how you supervise kids in face-to-face interaction. Most kids navigate going to and from school and participating in class with some, but very limited, parental supervision. Some kids need much more supervision. Electronic situations are something
that parents can supervise much more closely, as they are often with the child, or at least in the same house, when the communication occurs. Nonetheless, even if monitoring could be done (children will find ways to circumvent even the strictest supervision),
children view supervision as highly intrusive. In addition, studies have shown that electronic communication is used heavily by children for support, which means close monitoring interferes with the support they are receiving from friends and peers. So, yes,
for most children, it’s not recommended to ask to view all electronic communication.

Is it safer for kids not to have access to cell phones or social media? For most kids, electronic communication is not only the way they stay "in the loop" with their friends, but it is also the main way that they obtain social support. Taking this away protects them (and sometimes that is necessary) but it also denies
them avenues for normal social and emotional development.

If your child is on the receiving end of a cyberbully’s attentions, how should they respond? When should they seek an authority figure's help?First thing is to encourage them to bring in a parent for advice. I can’t emphasize enough, though, that I mean advice and not control. As soon parents clamp down on communication or take unwanted action, the child will stop communicating with them.
An authority figure is useful when the actions are repeated and damaging.

What signs of bullying should a parent look for if a child is unwilling to communicate about what is going on inside or outside of school?
First, be patient. You may need to wait but typically waiting patiently and being there for support works faster than putting pressure on a child to communicate when they clearly do not want to. Second, look for signs of depression: overt sadness, angering
more easily, isolating more, declining grades, less interest in seeing friends and other activities that had been considered fun. Some of this, such as self-imposed isolation, you may see as a consequence of normal development. However, when it is sudden,
or combined with other problems, consider a mental health evaluation.

Why do the bullied often become bullies?
Kids are commonly both bullies and victims. Unfortunately, being a victim may teach children that imposing one’s power on another is important, which predisposes them to becoming a bully. As a parent, if you encounter this, talk to your child about his/her
behavior and consider a mental health evaluation if the behavior persists.

If you do discover your child is being bullied, online or off, should you talk to your children and the parents of the other children involved before getting the school involved? Should the schools be told right away?For a bullying victim, being a victim is highly embarrassing in and of itself. First, consider interventions that are less of a "deal," as long as they are effective at stopping the bullying. On the other hand, bullying involving threats or encouraging
a child to commit suicide should be brought to the attention of the authorities immediately.

Does your child communicate with his or her friends online? How closely do you monitor activity?

Peter
Hulick, MD, MMsc, Medical Geneticist at NorthShore, discusses the increased risk for breast and ovarian cancer in women who carry the BRCA1 and BRCA2 gene mutation. He responds to the recent study from the
Journal of Clinical Oncology on the impacts these mutations have on women as well as identifies ways women can minimize their risk.

What are your general impressions of the new study? The study, particularly given its size, helps further parse out the details of risk differences between BRCA1 and BRCA2. There have been retrospective studies that have suggested this, but here we have a prospective study that adds further evidence.
In addition, it looks at overall reduction in mortality which shows the gains go beyond the ovarian cancer risk reduction.

Who is most at risk for having the BRCA1 and BRCA2 mutation?
There are many potential ways someone can be at risk, but certain characteristics stand out:

Anyone of Ashkenazi Jewish descent who has personal history of breast cancer or a personal history of ovarian cancer

Anyone diagnosed with breast cancer at age 45 or younger

Anyone diagnosed with ovarian cancer at any age

Ultimately, if you have been diagnosed with breast and or ovarian cancer, or multiple family members have, you should discuss the family history with a cancer risk specialist.

What is the difference between the two genes?
Both genes are involved in how the body repairs DNA damage that accumulates and maintaining the “checks and balances” that control cell growth. As this study reinforces, there are differences in cancer risks associated with each. While the risk for ovarian
and breast cancer might be somewhat lower for BRCA2 than BRCA1 (though still considered high compared to average risk), BRCA2 mutation carriers tend to have higher risk for other BRCA-related cancers (e.g. pancreatic, prostate).

What preventative measures can women engage in to minimize their risk of breast and ovarian cancer? The first step is to get an accurate assessment of one’s risk. Women may still be at elevated risk even if BRCA testing is negative. Other genes and non-genetic factors contribute to ovarian and breast cancer risk. Depending on the risk level, certain
options exist for increased screening, preventative medications or preventative risk-reducing surgery. This is a complex and very personal decision and accurate information about risk is key.

What screening options are available for women to learn more about their risk? The first thing women can do is to get an accurate family history from BOTH sides of the family, then discuss with one’s physician.

What next steps would you recommend for women with the BRCA1 / BRCA2 mutation? I would recommend women talk to their doctors about speaking to someone familiar with cancer genetics such as a geneticist, a genetics counselor, or a gynecologist/oncologist/breast surgeon knowledgeable about the management of BRCA carriers. There
are online resources from Be Bright Pink and FORCE that can be helpful in understanding the implications of having BRCA mutation and putting in a plan to reduce risk. As this study and others have shown, we have the ability to greatly reduce one’s risk if
we know one faces these risks.

Foot and ankle pain might be common in active, athletic individuals but that doesn’t mean it can or should be ignored.
If left unexamined, mild foot and ankle discomfort could lead to pain that disrupts day-to-day activities, or even lead to a more severe injury. Pain and noticeable discomfort are signs that there could be something wrong. Identifying the site and source of
the pain could be the first step to getting back on your feet, pain-free.

Plantar fasciitis. A common cause of heel pain, plantar fasciitis occurs when the plantar fascia, a band of tissue that connects the heel bone to the toes, becomes swollen or irritated. The pain is most severe after long periods of rest—first
thing in the morning or when climbing stairs—and it typically subsides the more active you are throughout the day. In older individuals, plantar fasciitis is caused by the natural wear and tear of aging. Plantar fasciitis is also a common injury in young athletes
and those who spend long periods of time on their feet. Treatment: There is no cure-all for plantar fasciitis. Giving your feet a break, cutting back on exercise or simply changing your shoes could relieve some or all of the pain. Stretching of the ankle and plantar fascia are also very important.
If you think you might be suffering from plantar fasciitis, discuss your treatment options with your physician.

Achilles tendonitis. Often an overuse injury, Achilles tendonitis is a swelling of the Achilles tendon, which extends from the heel to the calf muscle. Not stretching before and after physical activity, wearing high heels, or simply having
flat feet or fallen arches are all common causes of Achilles tendonitis. Tendonitis pain may be mild to moderate but the pain following an Achilles tendon tear will be sudden and severe. Treatment: If you give it the time and rest it needs, Achilles tendonitis will heal on its own, but make sure to see your physician to determine the extent of the injury. Your doctor will then help you determine the best way to proceed, which
could include rest or the use of crutches to keep your weight off the injury.

Stress fracture. Stress fractures are small cracks that develop in the bones of the feet, ankle and legs. For active individuals, they are most often caused by overuse in high-impact sports like distance running (e.g. feet repeatedly hitting
the ground). Worn out, unsupportive shoes as well as a sudden increase in physical activity might also be to blame. The most common locations of stress fractures are the second and third metatarsals in the foot, and the bone at the top of the foot called the
navicular. Pain from stress fractures will most likely develop gradually, increasing the more you are on your feet and decreasing when at rest. Also look for swelling and bruising at the site of the pain.Treatment: Rest is essential! Ignoring the pain could cause more serious injury, including a complete break of the stress-fractured bone. See your doctor to determine the exact location of the stress fracture; treatment varies depending on
the severity and location of a stress fracture.

Turf toe. Common in football players, turf toe is a sprain of the ligaments surrounding the big toe. It’s caused by a hyperextension of the toe, or bending back of the toe beyond the point of normal movement. Injury can occur from a sudden,
forceful movement or repeated hyperextensions over a period of time. Pain, swelling and limited movement of the big toe are all indicators of turf toe.Treatment: As with many overuse injuries, rest is best. Depending on the severity of the injury, your doctor might recommend immobilization, either by taping the injured toe to another to relieve the stress on the joint or the use of a cast
or boot.

Ankle sprain. With the ice and snow on the ground, ankle sprains are most common in the winter months. Mechanical twisting of the lower leg and ankle can cause simple ankle sprains, which will heal on their own, or high ankle sprains, which
can be more serious and require additional stabilization in a cast or boot. Other injuries such as ligament tears, tendon strain and cartilage injuries can all occur in an ankle sprain. Treatment: Most ankle sprains will heal on their own. Resting a short period to allow the initial pain and swelling to subside is common and you may need a brace or boot initially. Chronic pain after an ankle sprain is a clue that there is
something else going on. And that’s when it is important to see your doctor right away. Additional imaging and exam might be needed to clarify the situation and physical therapy might come into play.

“First and foremost, we’re looking for the best possible outcome,” says
Lalit Puri, MD, Orthopaedic Surgeon and Division Chair of Adult Reconstruction at NorthShore. And, according to Dr. Puri, the philosophy of the Total Joint Replacement Center at NorthShore is that the best possible outcomes are created from strong partnerships
between patients and healthcare professionals.

Dr. Puri shares more information on the partnerships formed between patients and their orthopaedic care teams at the NorthShore Total Joint Replacement Center:

Why is the partnership between patient and healthcare provider so important?
If we enter into a partnership with our patients, we’re asking the patient to give his or her best before and after surgery, just as we’ll give our best throughout as well.

We know that surgery can certainly be anxiety-provoking, but we don’t want patients to come into NorthShore feeling like that. So our partnerships are about trying to demystify the process. Our partnerships start with an open and honest dialogue.

Part of that demystification process is patient education. Why is educating the patient before surgery so important?
It’s critical that the patient has an understanding of what to expect before surgery. Most importantly because it reduces anxiety in the patient’s mind so that he or she is more comfortable with what’s ahead. I also think that the more educated a patient is
about surgery, the more he or she can participate in his or her care. A more informed patient has a better understanding of what is happening, and therefore may be a more active participant.

What does patient education at the Total Joint Replacement Center involve?
A key element of our partnership with the patient is our comprehensive Patient Education Program. This program guides patients through the entire process of a total joint replacement before surgery even happens, from pre-surgery preparation recommendations
to full rehabilitation.

Patients are encouraged to attend a class prior to surgery that is run by a team of specially trained orthopaedic nurses. In this class, they learn what they can do to be active participants in their own care, and have an opportunity to interact with many
of the clinicians who will be a part of their care teams.

The Patient Education Program is not just about educating patients though. Our multidisciplinary team uses this time to learn about the individual needs of each patient by asking and answering questions, getting to know each individual patient, to discover
the best way to help patients maximize their health before the surgical procedure.

Developing a regular exercise routine is one of the most important elements of a healthy lifestyle, and roughly 53% of Americans show their agreement by exercising three or more days a week. However, participation in any physical activity, whether it's hitting
the gym or the slopes, increases your risk for an exercise-related injury. Still, the health benefits of exercise far outweigh the risks, as long as you approach each new physical activity and sport armed with the right information.

Get fit but also stay safe with the help of our sports injury prevention infographic. Learn how to recognize common sports injuries that affect both athletes and energetic amateurs and use our simple, easy-to-follow sports injury prevention tips to keep
you pain free and active. Click on the link to view our full NorthShore University HealthSystem
infographic.

The update to a report first published 25 years ago in the British Medical Journal continues to raise important questions about the value of mammography; however, it must be considered in the context of other randomized trials that
confirm a significant reduction of breast cancer mortality in women who regularly undergo screening mammograms. This report shows, as it did previously, an improvement in survival rates for women who had their breast cancer detected via mammogram before clinical
signs of cancer had become apparent.

As screening technology continues to evolve, screening guidelines may be modified. At present, there is convincing data that women should have annual screening mammograms beginning at 40, as suggested by the American Cancer Society’s guidelines. Those with
a strong family history or a genetic predisposition may begin screening earlier after consultation with their physician.

Have medications and physical therapy done little to relieve your joint pain? Are you hoping to find a way to get
back to the things you love without having to worry about pain? Total joint replacement might be the next step, but it’s a step you shouldn’t take without asking some important questions first.

Ravi Bashyal, MD, Orthopaedic Surgeon, specializing in minimally invasive hip and knee replacement surgery at NorthShore, answers questions on total joint
replacement surgery, from what makes someone a good candidate to recovery, rehabilitation and beyond:

Who is a good candidate for joint replacement surgery?
Total joint replacement surgery is an excellent option for patients who have "worn out" their hip or knee joint, found little relief from conservative management options such as injections or medications, and who feel that their worn-out joint is significantly
impacting their ability to enjoy their daily activities and life.

Are there minimally invasive options for total joint replacement?
Yes. There are many new techniques and implants that allow total joint replacements to be done now in a much less-invasive fashion than in the past. These innovations can allow for shorter surgical times, lower complication rates and faster recovery. Talk
to your surgeon about his/her personal approach, and how you might fit into this as an individual patient.

What should a total joint replacement patient do prior to surgery?
There are numerous steps one should complete prior to a joint replacement surgery:

First and foremost, meet with an orthopaedic surgeon to make sure you are a good candidate for this type of surgery. He or she can talk to you about possible risks, recovery times and patient outcomes. Also make an appointment with your medical doctor and
any other specialists (i.e. cardiologist) to make sure you are medically cleared to safely proceed with surgery.

Attend a class regarding joint replacement at the NorthShore Total Joint Replacement Center. This is an excellent opportunity to participate in a program focused on hip and knee replacement. You'll have a chance to meet with nurses, physical therapists,
social workers, and other team members that will explain the ins and outs of what to expect before, during and after your surgery and during your hospital stay.

Make a pre-operative appointment with your surgeon and his/her team. This will give you a chance to review what you have learned during the pre-operative process, discuss any questions/concerns that may have come up, and to feel comfortable and confident
going into your surgery.

What can a patient do to help to ensure the best possible outcome?
Become a partner in your care. The Total Joint Replacement Center at NorthShore is there to guide patients from beginning to end, from pre-op to rehabilitation. Patients are encouraged to communicate with their surgeon but also with our highly trained orthopaedic
nurses and staff throughout the process. We feel that it’s important for our patients to have a thorough understanding of what to expect before, during and after surgery.

How long should you expect to be in the hospital after a total joint replacement?
Most of our hip-replacement and knee-replacement patients are ready to be discharged 2-3 days after their operation. Some patients are even ready to go home the day after. Many of our patients go directly home after surgery with in-home nursing and therapy
arranged by our social work team, while others elect to go to an inpatient rehab center prior to going home. Ask your surgeon what to expect, and discuss with him/her what would work best for your individual situation and preference.

While recovery time varies case by case, what timeframe for recovery should a patient of total joint replacement expect?
Recovery is different for everyone. With our use of minimally invasive techniques and advanced post-operative care, many patients are recovering at a much quicker pace than 10 or 15 years ago. We have many patients back to work and activities within a few weeks.
Of course, this is subject to individual recovery times, and the specific activities that each patient will return to after surgery. A discussion with your surgeon about your recovery is an important part of the pre-operative process.

What about long-term? How long should someone expect an implant to last?
Innovations in joint replacement technology have dramatically increased the longevity of many types of implants. Many currently available implants can survive for 20 or more years, and even if these devices "wear out," currently technology allows us to replace
only the worn-out part without having to re-do the entire operation or replace all the parts.